Management of sickle cell disease
Authors: Y. M Agble, N. Clare, P. Savundra, R. E J Kirkman, M. Elstein, J. M Knight, S. C Davies, L. Oni
Journal: BMJ (1998)

# Non-addictive analgesics can be as effective as morphine and pethidine {#article-title-2} EDITOR—I am concerned at the increasing use of pethidine and morphine analgesia in young African and Afro-Caribbean children with sickle cell anaemia, as described by Fertleman et al and by Davies and Oni. 1 2 I am astonished that a vulnerable section of the community is being given addictive drugs when non-addictive analgesics would be just as effective, particularly in a society where drug addiction among young people is recognised as a problem. I have nursed patients with sickle cell disease in Trinidad and in Ghana, where the numbers of sufferers are much larger than those found in the United Kingdom. Education of parents and children by public health nurses in schools and in the community about their condition, regular follow up by clinicians, and admission when in crisis, with paracetamol being given alone or in combination with codeine when something stronger is required, went a long way to ensuring a normal existence for such children. I remember only one occasion when pethidine was used, and that was given in a small dose to a patient in labour. More recently pethidine has been used in small doses in the Caribbean, but never morphine—for obvious reasons. I am baffled why children here should need it. The claim that parents and children are demanding opiates for pain control shows a lack of education and knowledge about the illness and the long term effect of such drugs on their part. I have come across several young addicts in hospitals across London, and I wonder how long it will be before they end up in a criminal situation. 1. 1.↵1. Fertleman CR, 2. Gallagher A, 3. Rossiter MA . Evaluation of fast track admission policy for children with sickle cell crises: questionnaire survey of parents' preferences. BMJ 1997; 315: 650. (13 September.) [OpenUrl][1][FREE Full Text][2] 2. 2.↵1. Davies SC, 2. Oni L . Management of patients with sickle cell disease. BMJ 1997;315:656-660. (13 September.) [OpenUrl][3][FREE Full Text][4] # Management would improve if doctors listened more to patients {#article-title-5} EDITOR—As a 51 year old patient with heterozygous sickle cell anaemia and a national campaigner for improved services in hospitals since 1974, I note that pethidine has been discounted for morphine infusions in the review article … [1]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DFertleman%26rft.auinit1%253DC.%2BR%26rft.volume%253D315%26rft.issue%253D7109%26rft.spage%253D650%26rft.epage%253D650%26rft.atitle%253DEvaluation%2Bof%2Bfast%2Btrack%2Badmission%2Bpolicy%2Bfor%2Bchildren%2Bwith%2Bsickle%2Bcell%2Bcrises%253A%2Bquestionnaire%2Bsurvey%2Bof%2Bparents%2527%2Bpreferences%26rft_id%253Dinfo%253Apmid%252F9310567%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/ijlink?linkType=FULL&journalCode=bmj&resid=315/7109/650&atom=%2Fbmj%2F316%2F7135%2F935.atom [3]: {openurl}?query=rft.jtitle%253DBMJ%26rft.stitle%253DBMJ%26rft.issn%253D0007-1447%26rft.aulast%253DDavies%26rft.auinit1%253DS.%2BC%26rft.volume%253D315%26rft.issue%253D7109%26rft.spage%253D656%26rft.epage%253D660%26rft.atitle%253DFortnightly%2Breview%253A%2BManagement%2Bof%2Bpatients%2Bwith%2Bsickle%2Bcell%2Bdisease%26rft_id%253Dinfo%253Apmid%252F9310570%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [4]: /lookup/ijlink?linkType=FULL&journalCode=bmj&resid=315/7109/656&atom=%2Fbmj%2F316%2F7135%2F935.atom